Abstract
Objective: To identify the impact of a collaborative pharmaceutical care service (CPCS) on medication safety and establish the impact of the CPCS on patient reported outcomes for Parkinson’s disease (PD) patients. Methods: Initially, PD outpatients receiving the CPCS between March 2017 and March 2019 were compared with PD patients receiving standard of care to identify differences in management. Pharmacist interventions data were coded and patients with PD receiving the CPCS were compared with those receiving standard of care to determine differences in medicines prescribed and dosage associated with these. Following this, data of patients receiving CPCS at baseline and 3-months follow-up were collected using a questionnaire consisting of validated measures of two patient-reported outcomes [adherence and quality of life (QoL)]. Mean scores for continuous variables were calculated, with descriptive analysis of categorical variables consisting of frequency counts and percentages. Change in adherence score before and after CPCS was investigated using a Wilcoxon sign rank sum test, spearman correlation analysis was used to correlate the changes in QoL before and after CPCS with the number of interventions, and p < 0.05 indicates that the difference is statistically significant. Results: A total of 331 PD outpatients received CPCS over 490 outpatient visits with an average age of 71.83 (±12.54). Five hundred and forty-five drug related problems were recorded as pharmacist interventions, of which most involved change to dosage (n = 226, 41.47%), adverse drug reactions (n = 135, 24.77%), and change in a medication (n = 102, 18.72%). Compared with those receiving standard of care, patients receiving CPCS were significantly less likely to have been prescribed pramipexole (18.52 versus 23.77%, p < 0.001) and more likely to have been prescribed amantadine (5.40 versus 3.70%, p = 0.02) and selegiline (17.36 versus 11.64%, p < 0.001). Lower dosages of levodopa/benserazide (0.51 ± 0.31 g versus 0.84 ± 0.37 g, p < 0.001), levodopa/carbidopa (0.33 ± 0.23 g versus 0.66 ± 0.47 g, p < 0.001), pramipexole (1.14 ± 1.63 mg versus 1.27 ± 0.69 mg, p = 0.01), and entacapone (130.00 ± 79.76 mg versus 173.09 ± 97.86 mg, p < 0.001) were also recorded. At baseline 119 PD outpatients with an average age of 69.98 (±9.90) were recruited for the longitudinal study. At 3-month follow-up, participants reported improvement in bodily pain subscale (baseline versus 3-months follow-up, 30.04 ± 22.21 versus 23.01 ± 20.98, p = 0.037) and medication adherence (6.19 ± 1.50 versus 6.72 ± 1.73, p = 0.014). Frequency of CPCS use was related to activity of daily living subscale (p = 0.047), the bodily pain subscale (p = 0.026), and medication adherence (p = 0.011). Total score of PDQ-39 was associated with patient education (p = 0.005) and usage and dosage combined with patient education (p = 0.006), while medication adherence score was associated with usage and dosage (p = 0.005). Conclusion: The CPCS was effective in resolving drug-related problems and in improving patients’ medication regimens, medication adherence, and QoL through patient education and dosage adjustments. This is the first step in the development and feasibility testing of pharmacy services for PD patients in China.
Highlights
Parkinson’s disease (PD) is a common neurodegenerative disease, with an estimated incidence rate of 37.55 per 100,000 personyears in females aged 40 and over and 61.21 in males aged 40 years and older, with incidence increasing with age (Hirsch et al, 2016)
These data were merged with patient demographic information extracted from outpatient records, with additional data related to patient medication history derived from the hospital electronic prescription information system to create a dataset consisting of patients with PD receiving the collaborative pharmaceutical care service (CPCS)
Severity of adverse events (AEs) was assessed by the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 as Grade 1 to 5 which was widely used in previous studies (Common Terminology Criter, 2017; Smith et al, 2021)
Summary
Parkinson’s disease (PD) is a common neurodegenerative disease, with an estimated incidence rate of 37.55 per 100,000 personyears (95% CI 26.20–53.83) in females aged 40 and over and 61.21 (95% CI 43.57–85.99) in males aged 40 years and older, with incidence increasing with age (Hirsch et al, 2016). While to date there is a lack of evidence regarding the contribution of pharmacists to patient outcomes in China, where the role of pharmacists has tended to focus more on medicines supply than on supporting patients to get the best outcomes from their medicines (Yi et al, 2016), studies undertaken in other countries such as Brazil and the United States have demonstrated the contribution of pharmacists to medicines management of patients with PD with patients’ adherence and QoL improved through pharmacists’ interventions (Poon et al, 2012; Foppa et al, 2016) Given this evidence that pharmacists can effectively have a positive clinical impact on patients’ OoL and drug related problems, an innovative service for patients with PD was developed at a 2,024-bed tertiary academic-teaching hospital in Beijing, the collaborative pharmaceutical care service (CPCS)
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